New approaches to treatment and prevention are resulting in longer survival of children who are HIV+. A consequence of this trend is a sharp acceleration in the number of HIV-affected children entering kindergarten. Psychosocial changes accompanying the start of kindergarten are sufficiently stressful to induce adrenocortical activation in healthy 5- year old children. Beyond these possible biologic effects the behavioral and psychosocial consequences of school entry may have an impact on the quality of life of HIV-affected children.